Biomarkers of Neurobiologic Recovery in Adults With Sport-Related Concussion.

Importance: Sport-related concussion (SRC), a form of mild traumatic brain injury, is a prevalent occurrence in collision sports. There are no well-established approaches for tracking neurobiologic recovery after SRC. Objective: To examine the levels of serum glial fibrillary acidic protein (GFAP) and neurofilament light (NfL) in Australian football athletes who experience SRC. Design, Setting, and Participants: A cohort study recruiting from April 10, 2021, to September 17, 2022, was conducted through the Victorian Amateur Football Association, Melbourne, Australia. Participants included adult Australian football players with or without SRC. Data analysis was performed from May 26, 2023, to March 27, 2024. Exposure: Sport-related concussion, defined as at least 1 observable sign and/or 2 or more symptoms. Main Outcomes and Measures: Primary outcomes were serum GFAP and NfL levels at 24 hours, and 1, 2, 4, 6, 8, 12, and 26 weeks. Secondary outcomes were symptoms, cognitive performance, and return to training times. Results: Eighty-one individuals with SRC (median age, 22.8 [IQR, 21.3-26.0] years; 89% male) and 56 control individuals (median age, 24.6 [IQR, 22.4-27.3] years; 96% male) completed a total of 945 of 1057 eligible testing sessions. Compared with control participants, those with SRC exhibited higher GFAP levels at 24 hours (mean difference [MD] in natural log, pg/mL, 0.66 [95% CI, 0.50-0.82]) and 4 weeks (MD, 0.17 [95% CI, 0.02-0.32]), and NfL from 1 to 12 weeks (1-week MD, 0.31 [95% CI, 0.12-0.51]; 2-week MD, 0.38 [95% CI, 0.19-0.58]; 4-week MD, 0.31 [95% CI, 0.12-0.51]; 6-week MD, 0.27 [95% CI, 0.07-0.47]; 8-week MD, 0.36 [95% CI, 0.15-0.56]; and 12-week MD, 0.25 [95% CI, 0.04-0.46]). Growth mixture modeling identified 2 GFAP subgroups: extreme prolonged (16%) and moderate transient (84%). For NfL, 3 subgroups were identified: extreme prolonged (7%), moderate prolonged (15%), and minimal or no change (78%). Individuals with SRC who reported loss of consciousness (LOC) (33% of SRC cases) had higher GFAP at 24 hours (MD, 1.01 [95% CI, 0.77-1.24]), 1 week (MD, 0.27 [95% CI, 0.06-0.49]), 2 weeks (MD, 0.21 [95% CI, 0.004-0.42]) and 4 weeks (MD, 0.34 [95% CI, 0.13-0.55]), and higher NfL from 1 week to 12 weeks (1-week MD, 0.73 [95% CI, 0.42-1.03]; 2-week MD, 0.91 [95% CI, 0.61-1.21]; 4-week MD, 0.90 [95% CI, 0.59-1.20]; 6-week MD, 0.81 [95% CI, 0.50-1.13]; 8-week MD, 0.73 [95% CI, 0.42-1.04]; and 12-week MD, 0.54 [95% CI, 0.22-0.85]) compared with SRC participants without LOC. Return to training times were longer in the GFAP extreme compared with moderate subgroup (incident rate ratio [IRR], 1.99 [95% CI, 1.69-2.34]; NfL extreme (IRR, 3.24 [95% CI, 2.63-3.97]) and moderate (IRR, 1.43 [95% CI, 1.18-1.72]) subgroups compared with the minimal subgroup, and for individuals with LOC compared with those without LOC (IRR, 1.65 [95% CI, 1.41-1.93]). Conclusions and Relevance: In this cohort study, a subset of SRC cases, particularly those with LOC, showed heightened and prolonged increases in GFAP and NfL levels, that persisted for at least 4 weeks. These findings suggest that serial biomarker measurement could identify such cases, guiding return to play decisions based on neurobiologic recovery. While further investigation is warranted, the association between prolonged biomarker elevations and LOC may support the use of more conservative return to play timelines for athletes with this clinical feature.

Nursing students' satisfaction with the quality of clinical placement and their perceptions of preceptors competence: A prospective longitudinal study.

BACKGROUND: Previous studies have demonstrated that preceptor training programs enhance preceptor competence and effectiveness. However, there is little research that has investigated the link between preceptor training and the quality of clinical placement. AIM: This study sought to determine if preceptor training influences nursing students' satisfaction with the quality of their clinical placement and their perceptions of preceptor competence. DESIGN: Prospective longitudinal survey. METHODS: A total of 189 nursing students from two Nursing Training Colleges in the north of Ghana were surveyed before and after a preceptor training program using two validated questionnaires. Data were analyzed using descriptive statistics and paired samples t-test. RESULTS: There was a statistically significant increase in student satisfaction with the quality of their clinical placement following preceptors' participation in a preceptor training workshop (t(149) = 4.567, p < 0.001). Student perception of preceptor competence also had a statistically significant improvement following preceptor training, increasing from an average of 136.96 ± 21.45 at baseline to 156.49 ± 25.403 in the follow-up survey (t(142) = 6.731, p < 0.001). Furthermore, the percentage of students who perceived preceptors to be highly competent increased from 23.3 % at baseline to 53.8 % following the preceptor training. CONCLUSION: The findings from this study indicate that when supported by preceptors who themselves have had training in effective preceptorship, students are more likely to report higher quality clinical placement and perceive preceptors to be more competent.

Burden experienced by informal caregivers of children with sickle cell disease (SCD): a qualitative exploratory study at Tamale Teaching Hospital, Ghana.

OBJECTIVE: This study sought to explore the burden experienced by informal caregivers in caring for their children with sickle cell disease (SCD). DESIGN: A qualitative exploratory design was employed in the study using in-depth interviews. SETTING: The study was conducted at the sickle cell clinic of the Tamale Teaching Hospital, Ghana. PARTICIPANTS: Data were gathered from 15 purposively selected informal caregivers, whose children with SCD received care at the sickle cell clinic of the Tamale Teaching Hospital, using a semistructured in-depth interview guide in May-June 2021. Their responses were audio-taped, transcribed and analysed using the reflexive thematic analysis approach. RESULTS: Five major themes emerged from data analysis. These were: the burden of children's ill-health; financial burden; employment challenges; psychosocial burden and determinants of caregivers' burden. These burdens destabilised the personal lives, financial standing, social relationships, and employment of caregivers in general and that of other immediate family members, thus, impacting family processes and health. CONCLUSIONS: Health professionals must devise strategies for counselling, early diagnosis and effective management of children with SCD across Ghana. The Ministry of Health must subsidise medications and laboratory services for children with SCD to help minimise the financial burden on caregivers. Further, counselling and psychological support services must be established in hospitals to assist caregivers to cope effectively.

Online learning experiences among nursing and midwifery students during the Covid-19 outbreak in Ghana: A cross-sectional study.

As a result of the COVID-19 pandemic, schools in Ghana were compelled to suspend routine learning activities and shut down to avert a possible public health crisis. As such, online learning was introduced as a temporary measure to ensure continuity in learning. For nursing and midwifery students who are usually more engaged in face-to-face practical learning, it will be interesting to ascertain how they experienced online learning during the COVID-19 pandemic in a technologically deprived country. Hence, data was collected from March to June 2021 using online methods and a cross-sectional study design among students of nursing and midwifery training colleges in the five regions of Northern Ghana. Logistic regression and descriptive analysis were conducted using SPSS (version 22) to determine the association between (1) socio-demographic factors, (2) internet exposure and accessibility factors, and the outcome variable; students' experiences. The results for 318 students revealed that pleasant experiences were below average (42.8%) and that reliable college internet connectivity, older age, year of study, and residence in southern Ghana were significant predictors of pleasant experiences. However, high cost of data and home distractions were identified as the main challenges to online learning. Therefore, it is important for nursing and midwifery training colleges in northern Ghana to establish robust information and communication technology infrastructure on their campuses to ensure reliable internet connectivity.

Preceptors' perceptions of support, commitment to the preceptor role, and preferred incentives: A cross-sectional study.

AIM: This study aimed to explore the perceptions of preceptors regarding the support they receive in the preceptorship role, their commitment to the role, and the incentives that are important to them. BACKGROUND: Nurse preceptors in Ghana face numerous challenges in performing their roles as preceptors. Preceptors require support from hospitals and nursing schools to make the preceptorship experience more rewarding for both students and preceptors. However, the type of support that preceptors require and their commitment to the preceptor role have been scarcely investigated in Ghana. DESIGN: This was a quantitative descriptive cross-sectional study. METHODS: An online survey that incorporated three questionnaires and a demographic information section was used to collect data from 154 preceptors in four hospitals in the northern part of Ghana. Data was analyzed using the Statistical Package for Social Sciences (SPSS) for Windows, version 26. Descriptive statistics, correlations, and multiple linear regression were used to analyze the data. RESULTS: Preceptors reported high levels of support in the preceptor role and perceived themselves to be highly committed to the role. Preceptors identified preceptor training, continuing education opportunities, and textbooks on effective preceptorship as the three most important incentives to them. No associations were found between perceived commitment and demographic characteristics of participants. CONCLUSIONS: Although many preceptors in Ghana feel satisfied with the support they receive to perform their role as preceptors, a significant number of preceptors do not feel adequately supported. Preceptor support should be geared more towards the professional development of preceptors.

Satisfaction with the quality of nursing care among older adults during acute hospitalization in Ghana.

AIM: This study assessed the level of satisfaction with the quality of nursing care among hospitalized older adults and the factors associated with it. DESIGN: This was a quantitative descriptive cross-sectional survey. METHODS: We used a validated questionnaire to collect data from a convenience sample of 206 older adults from three government hospitals in Tamale, Ghana. Data were analysed using descriptive statistics, independent sample t test and one-way ANOVA. RESULTS: Most of the participants (72.3%) reported moderate levels of satisfaction with the quality of nursing care, while 23.8% reported high levels of satisfaction. The association between gender, religion and level of satisfaction with nursing care was not statistically significant. However, patients differed on levels of satisfaction based on healthcare facility: patients at the Tamale Central Hospital were more satisfied with the quality of nursing care than those at the Tamale Teaching Hospital. There is a need for capacity building and sensitization workshops on the rudiments of geriatric care for nurses in the metropolis to serve as an impetus for improvement in the quality of care.

Nursing and Midwifery Students' Satisfaction with Their Clinical Rotation Experience: The Role of the Clinical Learning Environment.

BACKGROUND: The clinical learning environment and clinical rotation experience of students are integral to nursing curriculum and are a crucial component of nursing education which helps transform theoretical knowledge to clinical practical skills. OBJECTIVE: This study was aimed at assessing the role of the clinical learning environment on undergraduate nursing and midwifery students' satisfaction with their clinical rotation experience. METHOD: The study employed a quantitative cross-sectional survey design. Data was collected from a sample of 240 undergraduate nursing and midwifery students of the University for Development Studies, Tamale, Ghana, using a structured questionnaire. Ethical approval was obtained from the University of Cape Coast Ethics Review Board. Descriptive analysis was displayed as frequencies and percentages. Inferentially, Fisher's exact test, linear regression, and Spearman's correlation tests were used to test for and quantify associations between independent and dependent variables at p ≤ 0.05. RESULTS: The level of students' satisfaction with both clinical rotation experience and the clinical learning environment was high (65.6% and 63.5%, respectively). A statistically significant association of the students' satisfaction with their clinical rotation experience was found. There was a statistically significant relationship between the clinical learning environment (χ 2 (9, N = 224) = 80.665, p < 0.001), pedagogical atmosphere in the clinical area (r s = 0.379, p < 0.001), the leadership style of the ward manager (r s = 0.340, p < 0.001), the premises of nursing in the ward environment (r s = 0.501, p < 0.001), and the students' satisfaction with their clinical rotation experience. CONCLUSION: These findings provide nurse educators and clinicians with meaningful understanding about areas to prioritise when planning clinical learning opportunities in such a way that skills learning and practice of nursing skills are successful and satisfactory for undergraduate student nurses and midwives.

Knowledge of the Glasgow Coma Scale among Nurses in a Tertiary Hospital in Ghana.

BACKGROUND: Knowledge of the Glasgow Coma Scale (GCS) is recognized as an asset to all clinical nurses. However, many studies in different countries have reported low levels of knowledge of the GCS among nurses. Little is known about this subject in Ghana. OBJECTIVES: The aim of this study was to assess the knowledge of Ghanaian nurses about the Glasgow Coma Scale and identify factors associated with their knowledge. METHOD: This was a descriptive cross-sectional study involving a convenience sample of 115 nurses from a large teaching hospital in Ghana. We collected data using a structured questionnaire and analysed the data using descriptive statistics, Pearson's correlation, independent samples t-test, and one-way ANOVA. RESULTS: A little more than half of the participants (50.4%) had low knowledge of the GCS as a whole. However, with respect to basic theoretical concepts of the GCS, 62.6% of the participants had good knowledge about it, while only 5.2% demonstrated good knowledge on application of the basic knowledge in clinical scenarios. Working in Neurosurgical ward, female gender, and weekly performance of the GCS were associated with higher levels of knowledge. Academic qualification, years of experience as a nurse, and refresher training on GCS were not associated with knowledge. CONCLUSION: The findings from this study showed that nurses in Ghana have low levels of knowledge about the GCS. A more structured approach to teaching the GCS that is very thorough and done with demonstrations should be implemented to improve nurses' knowledge on the GCS.

Knowledge and Experience of Neonatal Resuscitation among Midwives in Tamale.

Background. Efforts to reduce under-five mortality across the globe are being hindered by a disproportionately high rate of neonatal deaths. About a quarter of these neonatal deaths are caused by birth asphyxia. Available evidence shows that effective neonatal resuscitation delivered by providers skilled in and knowledgeable about neonatal resuscitation can significantly reduce neonatal mortality rates. Objectives. This cross-sectional study was conducted to determine knowledge and experience in neonatal resuscitation among midwives in Tamale, and the factors associated with their knowledge on neonatal resuscitation. Methods. This was a cross-sectional study involving all midwives practicing in three large hospitals in Tamale. We developed a questionnaire to collect data on demographic characteristics of participants, and their knowledge and experience in neonatal resuscitation. We used the Statistical Package for Social Sciences (SPSS), version 21, to analyse the data. Demographic characteristics of participants were summarized using descriptive statistics. Pearson's correlation was used to determine associations between knowledge and some selected demographic features, while the one-way ANOVA was conducted to determine differences in level of knowledge based on the demographic features. Results. 98.1% of the participants in this study had insufficient knowledge on neonatal resuscitation. Midwives at the Tamale Central Hospital demonstrated a statistically significantly higher level of knowledge (24.67 ± 2.79, p = .014), compared to those at the Tamale Teaching Hospital (22.92 ± 4.56, p = .028) and Tamale West Hospital (21.50 ± 6.24, p = .021). Those who had a first-degree qualification in midwifery and those with a Post-NAC/NAP midwifery certificate had a statistically significantly higher knowledge than those with a diploma in midwifery. Training in neonatal resuscitation was associated with more knowledge in neonatal resuscitation (r(158) = .195, p = .013). In terms of experience, 55% of the participants in this study were not experienced in performing neonatal resuscitation. There were no differences in their level of experience based on their academic qualification, work place, and years of practice as a midwife. Conclusion. Considering the generally low level of knowledge and experience of midwives in neonatal resuscitation as discovered in this study, there is an urgent need for government to provide more opportunities for all practicing midwives to be trained in this important lifesaving skill.

Beyond the Diagnosis: Lived Experiences of Persons with Spinal Cord Injury in a Selected Town in Ghana.

BACKGROUND: Although several studies have been conducted on the lived experiences of persons with spinal cord injury (SCI) in high income countries, there is no published data on such experiences in Ghana. The purpose of this study was to explore the lived experiences of persons with SCI in the Tamale Metropolis of the Northern Region of Ghana. MATERIAL AND METHODS: A qualitative descriptive design involving thirteen participants was conducted at the Tamale Metropolis-Ghana. A purposive sampling technique was used to recruit participants, using the Neurosurgical Unit of the Tamale Teaching Hospital as an outlet for recruitment of the sample. Data was gathered mainly through face-to-face in-depth interviews. The data was analyzed concurrently with data collection, using thematic content analysis. Ethical approval was obtained for the study from the Noguchi Memorial Institute for Medical Research and the research unit of the Tamale Teaching Hospital. RESULTS: The three main themes that emerged from the data during analysis were "physical effects," "psychological effects," and "social issues." Conclusion. The findings from the study suggest that SCI is a life threatening condition and that persons with SCI grapple with a myriad of physical symptoms that range from chronic pain and paralysis of lower and/or upper limbs, to bladder and bowel incontinence. These physical symptoms have significant psychological and social effects on the functioning of the affected persons.